Levy Michael L, Luu Truc, Meltzer Hal S, Bennett Rebecca, Bruce Derek A
Division of Neurosurgery, Children's Hospital of San Diego, Suite 300, 8010 Frost Street, San Diego, CA 92123, USA.
Neurosurgery. 2004 Feb;54(2):488-90; discussion 490-1. doi: 10.1227/01.neu.0000103673.13196.7f.
Ventricular shunt infections are a major contributor to morbidity in patients being treated for hydrocephalus. The majority of these infections are from Staphylococcus epidermidis. Prevention of bacterial adhesion to the silicone surface of a ventricular catheter could decrease shunt infections. We studied the effectiveness of a surfactant and/or 2% iodine prewash on preventing bacterial adhesion to Silastic catheter material.
In a laboratory setting, various concentrations of a surfactant, Poloxamer-188 (P188), and a bactericidal agent, iodine, were compared against a control solution in their ability to prevent bacterial adhesion of S. epidermidis to a silicone surface. Silicone wafers were soaked for 1 hour in the test solution, then inoculated and incubated with S. epidermidis for 24 hours. Bacterial counts were then obtained and compared.
The most effective method tested in this study was 20% P188, which allowed only 3.02% bacterial adhesion compared with 22.2% bacterial adhesion in the control (P < 0.001). P188 at a 10% concentration or 20% mixed with iodine had the next most effective inhibition. Of the germicidal solutions, a 5-ppm solution of iodine was the most effective. The most ineffective method tested was 2 ppm iodine, which allowed 13.2% bacterial adhesion.
Use of a surfactant and/or a germicidal will provide some protection against bacteria attaching to silicone surfaces before they are surgically implanted. The use of a surfactant soak of 20% P188 or iodine at a concentration of 5 ppm before inoculation with S. epidermidis significantly decreased the bacterial adhesion to silicone wafers. This finding has relevance to clinical practice because it highlights a simple step undertaken before implanting a ventricular catheter that could reduce the adhesion rate of the most common contaminant of these catheters. This step may become an important factor in decreasing infection rates in shunt-dependent patients.
脑室分流感染是脑积水患者发病的主要原因。这些感染大多来自表皮葡萄球菌。防止细菌粘附在脑室导管的硅胶表面可减少分流感染。我们研究了一种表面活性剂和/或2%碘预洗在防止细菌粘附到硅橡胶导管材料上的有效性。
在实验室环境中，将不同浓度的表面活性剂泊洛沙姆-188（P188）和杀菌剂碘与对照溶液比较，看它们防止表皮葡萄球菌粘附到硅胶表面的能力。将硅胶片在测试溶液中浸泡1小时，然后接种表皮葡萄球菌并培养培养24小时。然后获得细菌计数并进行比较。
本研究中测试的最有效方法是20%P188，其细菌粘附率仅为3.02%，而对照组为22.2%（P<0.001）。浓度为10%的P188或与碘混合的20%P188具有次有效的抑制作用。在杀菌溶液中，5ppm的碘溶液最有效。测试的最无效方法是2ppm碘，其细菌粘附率为13.2%。
使用表面活性剂和/或杀菌剂将为细菌在手术植入前附着到硅胶表面提供一些保护。在接种表皮葡萄球菌之前，使用20%P188的表面活性剂浸泡液或浓度为5ppm的碘可显著降低细菌对硅胶片的粘附。这一发现与临床实践相关，因为它突出了在植入脑室导管之前采取的一个简单步骤，这一步骤可以降低这些导管最常见污染物的粘附率。这一步骤可能成为降低分流依赖患者感染率的一个重要因素。
